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Diagnosis and ambulatory   therapy of bleeding      abnormalities       Andreas Thurkow
Introduction                 • Diagnosis: how? (methods)                 • Therapy: how? (techniques)                 • Lo...
Diagnosis          • Anamnesis:                 – questionnaires                 – web-basedKvitfjell 2008                ...
Diagnosis          • Anamnesis          • Physical examinationKvitfjell 2008          thurkow@planet.nl
Diagnosis                QuickTimeª en een              Cinepak-decompressor          • Anamnesis (questionnaires, web-bas...
Diagnosis          •      Anamnesis (questionnaires, web-based)          •      Physical examination          •      US   ...
Shortcomings TVU  • echoscopic information on uterine    cavity depends on visualisation of the    endometrium            ...
SIS meta-analysis 6 prospective studies with 486 procedures Pre- en postmenopausal women Reference test: hysteroscopy •   ...
Efficacy SIS                                           one-stop• Dueholm (1999)          n=114            93%• Jones (2001...
QuickTimeª enen een                     QuickTimeª een en een                       QuickTimeª                     -decomp...
Diagnosis          •      Anamnesis (questionnaires, web-based)          •      Physical examination          •      US   ...
Diagnosis          •      Anamnesis (questionnaires, web-based)          •      Physical examination          •      US   ...
MRI uterus Submucous                        MyomaKvitfjell 2008          thurkow@planet.nl
AdenomyosisKvitfjell 2008     thurkow@planet.nl
One StopAbu et al. BJOG 2001: Quantitative and  qualitative assessment of women’s experience  of a one-stop menstrual clin...
Kvitfjell 2008   thurkow@planet.nl
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Ambulatory kvitfjell

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Transcript of "Ambulatory kvitfjell"

  1. 1. Diagnosis and ambulatory therapy of bleeding abnormalities Andreas Thurkow
  2. 2. Introduction • Diagnosis: how? (methods) • Therapy: how? (techniques) • LogisticsKvitfjell 2008 thurkow@planet.nl
  3. 3. Diagnosis • Anamnesis: – questionnaires – web-basedKvitfjell 2008 thurkow@planet.nl
  4. 4. Diagnosis • Anamnesis • Physical examinationKvitfjell 2008 thurkow@planet.nl
  5. 5. Diagnosis QuickTimeª en een Cinepak-decompressor • Anamnesis (questionnaires, web-based) zijn vereist om deze afbeelding weer te geven. • Physical examination QuickTimeª en een • US YUV420-codec-decompressor •3D? zijn vereist om deze afbeelding weer te geven. •Doppler! D.Timmermans US O&G 2003Kvitfjell 2008 thurkow@planet.nl
  6. 6. Diagnosis • Anamnesis (questionnaires, web-based) • Physical examination • US • SIS = SHGKvitfjell 2008 thurkow@planet.nl
  7. 7. Shortcomings TVU • echoscopic information on uterine cavity depends on visualisation of the endometrium BUT: in 10 - 40 %: NO endometrium is visible!Kvitfjell 2008 thurkow@planet.nl
  8. 8. SIS meta-analysis 6 prospective studies with 486 procedures Pre- en postmenopausal women Reference test: hysteroscopy • Sensitivity 94% (95% CI 91-97) • Specificity 89% (95% CI 85-94) • NPV 92% (89-97) • PPV 91% (87-95) • LR test + 8,5 (5,9-13,7) De Kroon et al. Ultrasound Obstet Gynecol 2002;20:S40Kvitfjell 2008 thurkow@planet.nl
  9. 9. Efficacy SIS one-stop• Dueholm (1999) n=114 93%• Jones (2001) n=93 89% No hysteroscopy• Brölmann (2003) n=457 93% (59%)• De Kroon (2003) n=214 84%Kvitfjell 2008 thurkow@planet.nl
  10. 10. QuickTimeª enen een QuickTimeª een en een QuickTimeª -decompressor -decompressor -decompressorzijn vereist omom deze afbeelding weer te geven. deze afbeelding weer te geven. zijn vereist om deze afbeelding weer te geven. zijn vereist
  11. 11. Diagnosis • Anamnesis (questionnaires, web-based) • Physical examination • US • SIS = SHG • HysteroscopyKvitfjell 2008 thurkow@planet.nl
  12. 12. Diagnosis • Anamnesis (questionnaires, web-based) • Physical examination • US • SIS = SHG • Hysteroscopy • MRIKvitfjell 2008 thurkow@planet.nl
  13. 13. MRI uterus Submucous MyomaKvitfjell 2008 thurkow@planet.nl
  14. 14. AdenomyosisKvitfjell 2008 thurkow@planet.nl
  15. 15. One StopAbu et al. BJOG 2001: Quantitative and qualitative assessment of women’s experience of a one-stop menstrual clinic in comparison with traditional gynaecology clinics126 (traditional) vs 113 (one-stop) Women were consistently more positive about their experience in the one stop clinicKvitfjell 2008 thurkow@planet.nl
  16. 16. Kvitfjell 2008 thurkow@planet.nl
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